Level Of Apex Research Articles

Periradicular Surgery Guided with Erbium Er Cr Laser:YSGG. Case Report

Purpose: The aim of the study is to observe the bone healing process of a guided periradicular surgery, performed in the endodontics postgraduate course of the University of Santo Tomas, in which an osteotomy was performed for a bone window with erbium, chromium: yttrium, scandium, gallium, garnet (Erbium,Chromium:YSGG) laser, and the healing process was evaluated by cone beam computed tomography (CBCT) during the first four months after surgery. Materials and Methods: After completing the clinical history and studying the CBCT scans, a patient was selected with a diagnosis of symptomatic apical periodontitis, periapical lesion less than 5mm with intact vestibular cortex that required periradicular surgery due to the presence of an adapted fixed prosthesis and the proximity of the mental foramen to the apex of the tooth to be treated. The treatment plan was established, the surgical guide was designed and the osteotomy was performed with Erbium,Chromium:YSGG laser. The size of the periradicular lesion and the bone density of the surgical area were measured at three points in time: pre-surgical (T0) and post-surgical at 24 hours (T1), at 4 months (T2) and at one year. Results: Bone density measured in Hounsfield units (HU) on CBCT in the axial section showed preoperative values in the vestibular apex of 1478 and 1435 HU, at 24 hours after surgery -95 and -210 HU, and in the control at 4 months of 992 and 860 HU. In the coronal slice in the mid vestibular area at the apex level, a preoperative value (T0) of 1335 HU was reported, at 24 hours (T1) -18 HU and at 4 months 1269 HU. At one year of evolution, greater bone density was evidenced comparing between month 4 and month 12. Conclusions: By performing a surgical procedure with guided technique and Erbium,Chromium:YSGG laser for the osteotomy, the adverse effects of the surgical procedures are reduced, achieving results with greater accuracy and better prognosis.

Variation of chin morphology and mandibular incisor length in different facial divergence patterns: New insights from CBCT records.

Evaluate constitutional differences in chin morphology and volume, and mandibular tooth size, between different facial divergence patterns. The sample consisted of 284 pretreatment cone beam computed tomography (CBCT) images of growing and non-growing patients who were stratified into 4 groups based on mandibular plane inclination to cranial base (SN) angle. Linear and angular measurements were made on the lateral CBCT images: mandibular lateral incisor crown (I-C) total (I-A) lengths, the distances between point D (centre of symphysis) and both incisor apex (D-A) and menton (D-Me) and between cemento-enamel junction and menton (CEJ-Me); chin width at the level of the central incisor apex (CWA) and point D (CWD); and the angles of the anterior and posterior symphyseal slopes. The volume of the symphysis was measured using a specialized 3D imaging software. Group differences and associations between parameters were gauged through the three-way ANOVA analysis. I-C, I-A, D-A, D-Me and CEJ-Me were greater in the hyperdivergent group (p < .001). CWA and CWD were wider in the hypodivergent group (p = .003). Volume of the chin and inter-slope angles were similar in all groups (p > .05). The anterior slope angle decreased with hyperdivegence (p < .005) in opposite pattern to the posterior slope angle (p < .005). Shape differences in mandibular symphysis were observed between opposite divergence patterns. Mandibular incisors were longer with hyperdivergence and shorter with hypodivergence. However, chin volumes were similar across divergence groups. These findings underline the role of genetic and environmental factors that impact facial growth.

Morphological and morphometric analysis of the Sacral Hiatus using lumbosacral spine CT scans: clinical relevance in Caudal Epidural Analgesia.

To conduct a morphological and morphometric analysis of the sacral hiatus (SH) using lumbosacral spine CT scans and to evaluate its clinical relevance in caudal epidural analgesia (CEA). This retrospective study analyzed 77 lumbosacral spine CT scans from a diverse patient population. The shape of the SH was classified into common types: inverted U, inverted V, irregular, and bilobed. Morphometric measurements included the length, width, and depth at the apex of the SH. The apex level of the SH was also determined in relation to the sacral vertebrae, and statistical analysis was performed to identify any correlation between the apex level and the morphometric dimensions. The most frequent SH shape was inverted U (68.83%), followed by inverted V (20.77%), irregular (9%), and a single instance of a bilobed shape (1.29%). The apex of the SH was most commonly located at the level of the S4 vertebra (75.32%), followed by the S3 vertebra (20.77%), S5 in two (2.59) and S2 in one (1.29%). No significant correlation was found between the level of the apex and the length, width, or depth of the SH. These findings indicate a high degree of anatomical variability in the SH, independent of the apex level. The anatomical variability of the SH, as observed in this study, underscores the need for individualized assessment during CEA. The lack of correlation between the apex level and the morphometric dimensions of the SH highlights the importance of imaging modalities such as ultrasound or fluoroscopy to ensure precise localization and effective analgesia administration. These insights can improve clinical outcomes by enhancing the accuracy and safety of caudal epidural procedures.

More molar distal movement than pretreatment cone-beam computed tomography posterior space available at the root level in mandibular dentition distalization with microimplants.

To compare the mandibular posterior space available before treatment and the distance of molar distalization achieved after mandibular dentition distalization with microimplants. A total of 66 Class I or III adult patients (mean age = 24.46 ± 4.89 years) who underwent molar distalization using microimplants were retrospectively included. The posterior space available distal to the second molar before treatment and the distance of distalization achieved after treatment were measured using axial cone-beam computed tomography images (0, 2, 4, and 6 mm apical to the second molar root furcation). Changes in lingual cortical thickness and molar root length after treatment were examined. Paired t-test or Wilcoxon signed-rank test was performed to compare measurements before and after treatment. Spearman correlation analysis was performed to assess the relationship between thinning of the cortical plate and root resorption. Achieved distalization distance was significantly greater than pretreatment posterior space available by 0.8 mm at all root levels (P < .001). The difference was greater toward the root apex level and greater in the Class III group than the Class I group. Lingual cortical thickness was significantly decreased after treatment along with resorption of the second molar distal root (P < .001). In addition, a positive correlation was found between thinning of the cortical plate and distal root resorption of the molar (P < .001). Achieved distalization distance of the mandibular molar using microimplants was greater than the pretreatment posterior space available. Thinning of the lingual cortex and root resorption were observed after distalization.

Symmetry, separation, and stability: Physical properties for effective dosimetric space with a stabilized hyaluronic acid spacer.

The proximity of the rectum to the prostate in radiation therapy (RT) for prostate cancer presents a significant dosimetric challenge, leading to high rectal doses and resulting in detrimental side effects. Perirectal tissue spacing reduces rectal dose and gastrointestinal toxicities by mechanically separating these organs. A variety of materials have been explored for use as rectal spacers, most recently, a stabilized hyaluronic acid (HA) gel, which can be formed into deliberate a shape, and retains the definition of that shape, while remaining flexible, unlike polyethylene glycol (PEG) hydrogels. This study evaluates the dosimetric impact of the spacer, including shape symmetry, the degree of separation at different locations, and the temporal stability of the space. Our goal is to provide physics-informed guidance on the optimal use of this sculptable spacer. A secondary analysis was performed on data from a 13-center prospective randomized trial (NCT04189913), involving 136 patients with centrally-reviewed treatment plans conducted on CT/MR simulation scans before and after receiving HA spacer implants. Patients were treated with 60Gy in 20 fractions to the prostate. For this study, python software was utilized for automated processing of DICOM RTstruct and RTdose files, facilitating detailed analysis of the spacer's impact on anatomical displacement and dosimetric outcomes. Complete dose-volume histograms (DVHs) were reconstructed, and combined into composite population DVHs before and after implant, verified against trial-reported dose points. Patients were divided into similar groups of separation and symmetry, and differences in their composite DVHs were tested for significance. Stability of the spacer was studied by comparing serial MRI images and by computing the distance between contours at four axial planes, at simulation and 3-month follow-up, post RT. The introduction of the HA spacer significantly enhanced rectal sparing, as evidenced by a reduction in the mean rectal integral dose by over 6Gy. High rates of implant symmetry(>95%) were observed, indicating nearly optimal lateral spacer placement. In superior-inferior coverage, this study like many others, saw the spacing largest at the superior extent but becoming more variable inferiorly at the level of the prostate apex. This allowed study of the apex as a specific area for dosimetric concern. Stability assessments confirmed that the spacer maintained its position and dimensions between the simulation and the 3-month post-RT, implying stable geometry during treatment, with only minimal separation changes observed. Statistical analysis using the Kruskal-Wallis test revealed significant correlations of larger separations at the inferior and apical planes with improved dosimetric outcomes, including rV30Gy. The use of a stabilized HA spacer in prostate RT effectively enhances prostate-rectum separation, leading to significant rectal sparing without undesirable dose compromises. This study underscores the role of strategic placement and shape, specifically including>1cm separation from the base down to the prostate apex. When combined with the treatment planning techniques used in the trial to create a steep dosimetric gradient across the spacer, these findings elucidate the dosimetric outcomes that can be expected in the clinical implementation of HA spacer. This is particularly relevant in the evolution of hypofractionated treatment regimens for prostate cancer therapy.

Determining the vertebra for pedicle subtraction osteotomy in surgical correction for ankylosing spondylitis with thoracolumbar kyphosis

OBJECTIVE This study aimed to provide a method for determining the apical vertebra for pedicle subtraction osteotomy (PSO) in corrective surgery for patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis (TLK). METHODS The medical records of AS patients with TLK who underwent PSO between May 2009 and August 2022 were retrospectively reviewed, and 235 patients were included in the study. Using the proposed method, choosing the vertebra based on Kim’s apex (KA), which is defined as the farthest vertebra from a line drawn from the center of the T10 vertebral body to the midpoint of the S1 upper endplate, the authors analyzed 229 patients with apices at T12, L1, or L2 (excluding L3 because of the small sample size, n = 6). They divided all patients into two groups. Group A (n = 144) underwent PSO at the KA vertebra, while group B (n = 85) underwent PSO at a different level. Demographic and radiological data, including sagittal spinopelvic parameters of the entire spine, were collected. An additional analysis was performed on patients with the same KA vertebra. RESULTS The vertebra distributions of patients based on KA were T12 (28 [12.2%]), L1 (119 [52.0%]), and L2 (82 [35.8%]). The corrections of sagittal vertical axis (SVA; 101.0 ± 48.5 mm vs 82.0 ± 53.8 mm, p = 0.010), global kyphosis (GK; 31.6° ± 10.0° vs 26.4° ± 10.5°, p = 0.005), and TLK (29.4° ± 10.2° vs 24.2° ± 12.9°, p = 0.012) in group A were significantly greater than those in group B, and there was no difference in the corrections of thoracic kyphosis (TK), lumbar lordosis, and pelvic incidence between the two groups. On further analysis, group A showed greater correction in TK (26.2° ± 13.7° vs 0.1° ± 8.1°, p = 0.013) for patients with T12 as the KA; greater improvements in SVA (101.5 ± 44.2 mm vs 73.4 ± 48.7 mm, p = 0.020), GK (30.6° ± 11.0° vs 25.0° ± 10.4°, p = 0.046), and TLK (32.6° ± 7.8° vs 26.7° ± 9.9°, p = 0.012) for those with L1 as the KA; and significant correction in TLK (30.0° ± 6.3° vs 4.3° ± 19.5°, p = 0.008) for patients with L2 as the KA, compared with group B. CONCLUSIONS PSO at the apical vertebra provides a greater degree of correction of sagittal imbalance. The proposed method, selecting the vertebra based on KA, is easily reproducible for determining the apex level in AS patients with TLK.

Palatal Morphology After Treatment of Children With Obstructive Sleep Apnoea Using the Modified Twin-Block Appliance

ObjectiveTo investigate changes in the upper maxillary palates of children with obstructive sleep apnoea (OSA) and mandibular retraction who were treated using modified twin-block appliances (MTBAs). MethodsThirty-five OSA children (age: 6-12 years) with mandibular retraction were included as the experimental group and 35 children who were Angle's class I but without mandibular retraction were included as the control group. The experimental group was treated with MTBA. Plaster models were made before the treatment and at the end of the 6-month treatment period. Plaster models of the control group were made at inclusion and after 6 months. Some plaster models were excluded because of damage or their failure to exhibit sufficiently clear marks, which left 26 pairs each for the experimental and control groups. The gender and age of the experimental group were matched with those of the control group at the end of the treatment. Three-dimensional (3D) digital model information was gathered using the external oral scanning model, and the data were extracted and analysed statistically to clarify the morphologic improvement in the maxillopalatine in OSA children treated using MTBAs. ResultsAfter the OSA children with mandibular retraction were treated with MTBAs, the maxillary intercusp width, intermolar width, anterior palate width, posterior palate width, and surface area and volume of the maxillary palate significantly increased (*P < .05). By contrast, the anterior palatal height–apex level (H3) significantly decreased (*P < .05). ConclusionsCompared with the control group, the narrow maxillary arch and basal bone were significantly enlarged after the OSA children with mandibular retraction were treated using MTBAs. The palatal surface area and volume increased, thereby allowing more space for accommodating the tongue and relieving transverse dissonance of the dentition.

Immediate implant placement in the anterior mandible: a cone beam computed tomography study

BackgroundThe placement of implants into the alveolar socket right after tooth extraction is called immediate implant placement (IIP). This approach has its particularities depending on which region of the jaws is involved. The anterior mandible region is peculiar due to the presence of mandibular incisors, which have the shortest roots among all permanent teeth.PurposeThis study aimed to investigate the factors that could be associated with the risk of either cortical bone wall perforation or invasion of the 2 mm secure distance from the surrounding anatomical structures (defined as unsafe implant placement), with IIP in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study.Materials and methodsCBCT exams from 239 eligible subjects were investigated. Implants were virtually placed in two distinct positions: prosthetically-driven (along the long axis of the existing tooth) and bone-driven position (according to the available bone and with regard to nearby anatomical structures). Correlation between several variables was tested, and binary logistic regression analysis in order to assess of the possible associations between covariates and unsafe placement was performed.ResultsSafe placing implants was significantly higher for the bone-driven in comparison to the prosthetically-driven position (22.2% vs. 3.3%, respectively), and the 2-mm secure distance from anatomical structures was not possible to respect in the majority of cases (77.6% vs. 82.9%, respectively). Covariates associated with a higher risk of unsafe placement were tooth region (CI in relation to IL and CA), decrease of labial concavity angle (LCA), decrease of mandible basal bone height (MBBH), and decrease in mandibular bone thickness at the tooth apex level (MBT0).ConclusionThe possibility of safely placing immediate implants in the anterior mandible is significantly higher for bone-driven than in prosthetically driven position. Presurgical virtual planning with CBCT is a great tool for minimizing the risk of implant unsafe placement with regards to the anatomical conditions in the mandible.

Neural Arch Preservation-Posterior Vertebral Column Resection: 2-Dimensional Operative Video.

This technique is a modification of the posterior vertebral column resection (PVCR) for patients with kyphoscoliosis with vertebral column resection indications (Cobb angle >100° angular and rigid with flexibility <20%-30%). The neural arch (preservation)-PVCR has the biomechanical advantage of maintaining the dural sac and the spinal cord attached within the neural arch and ligamentum flavum (dorsal meningovertebral ligaments are in tension in kyphosis), avoiding spinal cord deviation during the vertebrectomy. Preserving the neural arch did not interfere with corrective maneuvers of the anterior and middle columns and avoided the spinal translation in any anatomic plane. Standard posterior spinal midline approach and insertion of pedicle screws, a temporary rod is placed on contralateral side to maintain the stability of the spine during neural arch (preservation)-PVCR and to prevent translation of the spine. A costotransversectomy for an anterior approach is performed in the apex level and discectomies of the upper and lower levels. The anterior column reconstruction is made with a structural graft or titanium mesh cage with autograft. The correction is made with compression of the segment of the osteotomy, kyphosis correction with "in situ" rod benders, and Cantilever maneuver for final correction. A multiple rod construction is placed to increase stability. This technique has the potential benefits of decreasing operative time and blood loss, protecting the neural elements from fibrous scars and more posterior fusion for decreasing pseudoarthrosis. The patient consented to the procedure. The participants and any identifiable individuals consented to publication of his/her image.

CT Images in Follicular Lymphoma: Changes after Treatment Are Predictive of Cardiac Toxicity in Patients Treated with Anthracycline-Based or R-B Regimens

The aim of this study is to evaluate changes in epicardial adipose tissue (EAT) and cardiac extracellular volume (ECV) in patients with follicular lymphoma (FL) treated with R-CHOP-like regimens or R-bendamustine. We included 80 patients with FL between the ages of 60 and 80 and, using computed tomography (CT) performed at onset and at the end of treatment, we assessed changes in EAT by measuring tissue density at the level of the cardiac apex, anterior interventricular sulcus and posterior interventricular sulcus of the heart. EAT is known to be associated with metabolic syndrome, increased calcium in the coronary arteries and therefore increased risk of coronary artery disease. We also evaluated changes in ECV, which can be used as an early imaging marker of cardiac fibrosis and thus myocardial damage. The R-CHOP-like regimen was associated with lower EAT values (p &lt; 0.001), indicative of a less active metabolism and more adipose tissue, and an increase in ECV (p &lt; 0.001). Furthermore, in patients treated with anthracyclines and steroids (R-CHOP-like) there is a greater decrease in ejection fraction (EF p &lt; 0.001) than in the R-B group. EAT and ECV may represent early biomarkers of cardiological damage, and this may be considered, to our knowledge, the first study investigating radiological and cardiological parameters in patients with FL.

Reappraisal of the anatomical diversities of the pyramidalis muscle with their potential clinical applicability: cadaveric analysis.

The present study examined the morphology and morphometric parameters of the pyramidalis muscle (PM) in detail with their potential applicability in making midline infra-umbilical incisions and biomechanics of the linea alba. PM was examined in 51 formalin-fixed cadavers (36 males and 15 females), and based on the mode of insertion or the level of apex, the formation or shape of the muscle was classified into nine types (Mori's classification). Bilateral PM was more prevalent (39.21%) than unilateral (1.96%) (p = 0.001). All the cases showed side symmetry except one. Mori's type 7 (right PM is higher apex and the left PM with elongated origin) was the most common form. The mean length of PM in males and females was 4.51 ± 0.14 and 3.33 ± 0.12cm on the right and 4.51 ± 0.11 and 3.26 ± 0.16cm on the left side. The mean width of right-sided PMs in males and females was 1.90 ± 0.17 and 1.58 ± 0.13cm and left-sided 1.88 ± 0.14 and 1.55 ± 0.38cm. The mean of pyramidalis-pubo-umbilical index (PPI) in males and females was 32.82 ± 1.65 and 27.50 ± 1.08, respectively. The mean insertion angle was 24.56 ± 3.07 on right side and 23 ± 2.03 on the left side (p = 0.03). Male predominance existed on right- and left-sided PM length (p < 0.001 and p < 0.001), width (p = 0.001) and PPI (p = 0.001). The strong positive correlation (r = 0.83) between length and width indicates a symmetrical muscle augmentation in the two dimensions. PM is an inconsistent anatomical structure with persistent morphology. The level and angle of insertion into the linea are crucial in the biomechanics of linea alba. PPI, determining the termination level would be useful to surgeons making midline infra-umbilical incisions.

Periodontal Outcomes in Anterior Teeth following Presurgical Orthodontic Decompensation in Patients with Skeletal Class III Malocclusion: A Single-Arm Systematic Review and Meta-Analysis.

This study aims to systematically review and analyze the periodontal outcomes of presurgical orthodontic decompensation (POD) in patients with skeletal Class III malocclusion and to identify the key influencing factors. Material and Methods. We searched the Web of Science, PubMed, Scopus, Embase, and Cochrane Library databases. The outcomes included measurements related to periodontal soft or hard tissues. A total of 3,904 records were found, of which 10 were included. The meta-analysis revealed significant alveolar bone loss in mandibular incisors on both the lingual and labial sides during POD, with a more pronounced loss on the lingual side at the apex level and on the labial side near the crown. The maxillary incisors demonstrated significant bone loss, primarily on the lingual side. No significant bone loss was observed during postsurgical orthodontic treatment. Gingival recession was statistically significant but had a minor clinical impact. Incisor proclination was found to influence the gingival recession. However, no correlation was observed between bone loss and incisor proclination, vertical facial type, or sex. POD for skeletal Class III patients results in alveolar bone loss, particularly on the lingual side at the mandibular incisors' apex level and labial side at the crown level, and clinically acceptable gingival recession.

Restoration-oriented anatomical analysis of alveolar bone at mandibular first molars and implications for immediate implant placement surgery: a CBCT study.

This cone-beam computed tomography (CBCT) study aimed to analyze the anatomical characteristics of alveolar bone at mandibular first molar (MFM) and their implications for immediate implant placement surgery. 100 patients with 140 MFMs were reviewed retrospectively. We first performed a 3D reconstruction of the patient's CBCT data to determine a reference plane with ideal implant placement and orientation. The following parameters of MFM region were analyzed: mesial-distal socket size (MD-SS), buccal-lingual socket size (BL-SS), root furcation fornix to inferior alveolar nerve (IAN) distance (RF-I), interradicular bone thickness (IRB), mesial/distal root apex to the IAN distance (MRA-I/DRA-I), thickness of the buccal/lingual bone of the mesial root (MR-B/MR-L), thickness of the buccal/lingual bone of the distal root (DR-B/DR-L). The MD-SS of MFM was 8.74 ± 0.76 mm, and the BL-SS was 8.26 ± 0.72 mm. The MR-B, DR-B was 1.01 ± 0.40 mm and 1.14 ± 0.50 mm, and the difference was statistically significant (P = .001). The values of the MR-L, DR-L were 2.71 ± 0.78 mm and 3.09 ± 0.73 mm, and the difference was also statistically significant (P < .001). The mean distance of RF-I was 15.68 ± 2.13 mm, and the MRA-I was 7.06 ± 2.22 mm, which was greater than that of DRA-I (6.48 ± 2.30 mm, P < .001). The IRB at 2 mm, 4 mm apical from the furcation fornix, and at apex level was 2.81 ± 0.50 mm, 3.30 ± 0.62 mm, and 4.44 ± 1.02 mm, respectively. There is relatively sufficient bone mass in interradicular bone in height, but an adequate width is lacking for the bone between the mesial and distal root after the extraction of the MFM for immediate implantation. The thickness of the MFM buccal bone is relative thin, especially for the mesial root.

Association of Apical Spacing with Bowel Quality-of-Life: A Secondary Analysis of the Hyaluronic Acid Randomized Trial.

Recently, a randomized trial (NCT04189913) reported that a hyaluronic acid (HA) rectal spacer reduced acute grade 2+ gastrointestinal (GI) toxicity for hypofractionated radiation therapy (RT). However, 26.5% of patients who received the spacer experienced a minimally clinically important difference (MCID; 5 points) in EPIC bowel quality-of-life (QOL). We evaluated whether characteristics of the spacer implant, particularly apical separation, were associated with change in bowel QOL at 3-months and acute grade 1+ GI toxicity. We conducted a secondary analysis of 136 patients randomized to receive the HA spacer. The post-spacer implant structure sets and treatment plans were analyzed. The mid-plane (MP) was defined as the prostate center-of-mass. Four horizontal planes were defined at the superior (MP +1 cm), mid-gland, inferior (MP - 1 cm), and apex of the prostate. Separations between the prostate and anterior rectal wall at midline were computed at each plane in a custom Python programming environment. Implant symmetry was computed based on a previously published method (Fischer-Valuck, PRO, 2017). The volume of rectum receiving > = 30 Gy (rV30) was extracted from DVHs; rV30 has been associated with bowel frequency, fecal incontinence, and rectal pain for hypofractionated RT (Wilkins, IJROBP, 2020). First, we evaluated whether any of the 4 separation or symmetry variables were associated with rV30. Then, we evaluated whether significant spacing variables, rV30, and baseline bowel QOL were predictive of the change in bowel QOL at 3-months using multivariate linear regression. Finally, we evaluated whether significant spacing variables and rV30 were predictive of acute grade 1+ GI toxicity (21 events) within 3-months, utilizing multivariate logistic regression. The mean (standard deviation) superior, mid-gland, inferior, and apex separations were 15.6 (SD 6.0), 12.7 (3.7), 11.2 (3.7), and 9.7 (4.0), respectively. 130 of 136 (95.6%) had a symmetry score of 1 (symmetric). Apical separation was the only variable significantly associated with rV30 (r = -0.32; p < 0.01). On multivariate analysis, apical separation (0.41/mm; p = 0.01) was significantly associated with the change in bowel QOL, after adjusting for baseline bowel score (p = 0.0002) and rectum V30 (p = 0.50). Mean (SD) changes in bowel QOL were 0.01 (5.9) and -3.7 (8.1) for apical separations > = 10 vs <10 mm, respectively. Respective percentages of patients with a bowel MCID were 14.8% and 36.6% (p = 0.006). However, apical separation was not associated with increased odds of experiencing grade 1+ GI toxicity (p = 0.98), when adjusted for rectum V30 (odds ratio 1.04; p = 0.04). Increased apical separation may be associated with improved EPIC bowel QOL at 3-months for patients who received a HA rectal spacer prior to hypofractionated RT. This finding is clinically important, because HA can be deliberately injected into the perirectal space at the level of the prostate apex.

Quantification of the apical palatal bone index for maxillary incisor immediate implant assessment: A retrospective cross-sectional study

BackgroundApical palatal bone is important in immediate implant evaluation. Current consensus gives qualitative suggestions regarding it, limiting its clinical decision-making value. ObjectivesTo quantify the apical palatal bone dimension in maxillary incisors and reveal its quantitative correlation with other implant-related hard tissue indices to give practical advice for pre-immediate implant evaluation and design. Material and methodsA retrospective analysis of immediate implant-related hard tissue indices in maxillary incisors obtained by cone beam computed tomography (CBCT) was conducted. Palatal bone thickness at the apex level (Apical-P) on the sagittal section was selected as a parameter reflecting the apical palatal bone. Its quantitative correlation with other immediate implant-related hard tissue indices was revealed. Clinical advice of pre-immediate implant assessment was given based on the quantitative classification of Apical-P and its other correlated immediate implant-related hard tissue indices. ResultsApical-P positively correlated with cervical palatal bone, whole cervical buccal-palatal bone, sagittal root angle, and basal bone width indices. while negatively correlated with apical buccal bone, cervical buccal bone, and basal bone length indices. Six quantitative categories of Apical-P are proposed. Cases with Apical-P below 4 mm had an insufficient apical bone thickness to accommodate the implant placement, while Apical-P beyond 12 mm should be cautious about the severe implant inclination. Cases with Apical-P of 4–12 mm can generally achieve satisfying immediate implant outcomes via regulating the implant inclination. ConclusionsQuantification of the apical palatal bone index for maxillary incisor immediate implant assessment can be achieved, providing a quantitative guide for immediate implant placement in the maxillary incisor zone.

Radiographic assessment of sacral hiatus anatomy with backache.

To determine hiatal variations in cases of backache and controls on radiographs and association of age groups with hiatal parameters in patients with backache versus normal individuals. This case control study on 178 patients (89 cases and 89 controls), aged from 18-65 years, selected by non-probability convenience sampling was conducted at Radiology Department of PNS Shifa Hospital, Karachi over six months.The sacral hiatus was identified on lumbosacral spine radiographs. Both metric and non-metric parameters of hiatus with respect to sacral vertebra were noted and compared between the groups. Inverted "U" was the most common type observed in cases with base of hiatus at S5 level. Comparison of hiatal shape among different age groups showed inverted "U" and inverted "V" types among all age groups. Hiatal anteroposterior diameter and width were greatest in 36-45-year age group, and it was longest in 46-55-year age group. Determination of relationship between sacral hiatal parameters and incidence of low back pain showed positive association of inverted "U" and "M" shapes with back pain. Increased risk of back pain was observed with high apex (first sacral vertebra (S1)). Strong positive correlation was determined with inverted "U" and "M" shapes, and level of apex at S1 with low backache.

Alveolar bone changes around maxillary incisors after intrusion and retraction with controlled tipping versus bodily movement : Aretrospective cone-beam computed tomography study.

To compare the effect of maxillary incisor intrusion and retraction with controlled tipping (CT) versus bodily movement (BM) in extraction cases on alveolar bone height and thickness, using cone-beam computed tomography (CBCT). Correlations between changes in alveolar dimensions and crown or root retraction, incisor inclination, and intrusion were also investigated. In all, 144 incisors of 36 women were retrospectively evaluated. All patients were treated with anterior intrusion and retraction with either controlled tipping (CT) (group1) or bodily movement (BM) (group2). CBCT scans were taken before and after retraction and intrusion and measurements of alveolar bone height and thickness at the level of mid-root and root apex were measured. The prevalence of dehiscence was also calculated. Labial bone thickness (BT) increased at the level of the root apex with increased total BT in the CT group (p < 0.05). The BM group showed decreased palatal BT. Significant vertical bone loss with an increased incidence of dehiscences occurred on the palatal side in both groups. Changes in palatal bone area was negatively correlated with the amount of root apex retraction, while the total BT at the level of root apex was positively correlated with amount of intrusion. Bodily retraction can result in reduced palatal bone dimensions and an increase risk of iatrogenic sequelae following anterior retraction in extraction cases. Vertical bone loss and an increased incidence of dehiscences is to be expected following anterior retraction. Careful attention must be paid to the bone boundary conditions to avoid moving the incisors out of the alveolar housing.

Evaluation of the Possible Relationship between the Curvature and Horizontal Course of the Inferior Alveolar Canal.

The position of the inferior alveolar canal (IAC) and its course in the mandible is crucial to prevent complications in oral surgical procedures. Therefore, the present study aims to predict the course of IAC using landmarks specific to the mandible and to correlate with cone-beam computed tomography images. On the included panoramic radiographs (n=529), the closest point of the IAC to the inferior border of the mandible (Q) was determined, and the distances of this point to the mental (Mef) and mandibular foramen (Maf) were measured in millimeters. To determine the buccolingual course of the IAC on CBCT images (n=529), the distances from the center of the canal to the buccal and lingual cortices and between the cortices were measured at the level of the root apices of the first and second premolars and molars. Also, the positions of the Mef to adjacent premolars and molars were classified. The most common position of mental foramen was Type-3 (37.1%). On the coronal plane, it was also observed that as the Q point approaches the Mef, the IAC is located in the mandible's center at the second premolar level (p=0.008) and moves away from the midline at the level of the first molar (p=0.007). Based on the results, a correlation was observed between the horizontal course of the IAC and its proximity to the inferior border of the mandible. Therefore, the curvature of the IAC and its proximity to the mental foramen should be considered in oral surgeries.

Complexity in the use of 5G technology in China: An exploration using fsQCA approach

Despite the studies probing the factors associated with the adoption of 5G technology products, the current state of knowledge about this new technology products is still fragmented. Previous research has mainly concentrated on the “cumulative impact” of factors rather than the complexities of behavior. Based on complexity theory, this article aims to explain the behavioral intention of using 5G technology products by evaluating the combination of functional (i.e. price and quality), social (i.e. environmental awareness and knowledge) and consumer personality (i.e. openness and consciousness) factors as causal configuration. A sample of 150 Chinese consumers was examined using the fuzzy set qualitative comparative analysis (fsQCA) technique. The fsQCA outcomes illustrate that five different and effective configurations of functionality, social, and consumer personality factors exist to attain apex level intention of using 5G technology products. This article extends the existing literature by espousing a new procedural attitude to divulge the intricacy of 5G products adoption. It also provides valuable suggestions for 5G technology service managers and manufacturers to enhance the technology, social, and consumer personality features combination to implement 5G technology products successfully.

Mandibular alveolar bone thickness in untreated Class I subjects with different vertical skeletal patterns: a cone-beam computed tomography study.

To evaluate the mandibular alveolar bone thickness in untreated skeletal Class I subjects with different vertical skeletal patterns. A total of 50 preorthodontic treatment cone-beam computed tomography (CBCT) images of a skeletal Class I Chinese population with near-normal occlusion were selected. The buccal and lingual alveolar bone thicknesses of mandibular canines to second molars were measured at 2 mm below the cementoenamel junction (CEJ), mid-root, and root apex levels. Differences in the measurements were analyzed with Mann-Whitney U-test. The correlation between alveolar bone thickness and the sella-nasion-mandibular plane (SN-MP) angle was calculated using Pearson correlation coefficients and linear regression analysis. Buccal alveolar bone was thinner on all mandibular canines to first molars but thicker on second molars in comparison with lingual alveolar bone. Buccal alveolar bone was within 1 mm at the levels of 2 mm below CEJ and mid-root for the canines and first premolars. Significant differences were detected among subjects with different vertical patterns, with a negative correlation between the SN-MP angle and alveolar thickness, especially in the canine and premolar regions. The thinnest buccal and lingual alveolar bone were detected in the high-angle group canine region (0.50 mm at the levels of 2 mm below CEJ and mid-root for the buccal side, 0.90 mm at the level of 2 mm below the CEJ for the lingual side). To avoid periodontal complications, buccal-lingual movement of the mandibular canines and first premolars should be limited, especially in high-angle patients.